CANCER RESEARCH AND TREATMENT (CRT)

Original Article

Prevalence of Women with Dense Breasts in Korea: Results from a Nationwide

Cross-sectional Study

Hye-Mi Jo, MPH1, Eun Hye Lee, MD, PhD2, Kyungran Ko, MD, PhD3, Bong Joo Kang, MD,

PhD4, Joo Hee Cha, MD, PhD5, Ann Yi, MD, PhD6, Hae Kyoung Jung, MD7, Jae Kwan Jun,

MD, PhD1 and on behalf of the Alliance for Breast Cancer Screening in Korea (ABCS-K)

le
1
National Cancer Control Institute, National Cancer Center, Goyang, 2Department of Radiology,

ic
Soon Chun Hyang University Bucheon Hospital, Soon Chun Hyang University College of

Medicine, Bucheon, 3Center for Breast Cancer, National Cancer Center Hospital, National

t
Ar
Cancer Center, Goyang, 4Department of Radiology, College of Medicine, The Catholic

University of Korea, Seoul, 5Department of Radiology, Research Institute of Radiology, Asan

Medical Center, University of Ulsan College of Medicine, Seoul, 6Department of Radiology,

ed

Gangnam Healthcare Center, Seoul National University Hospital, Seoul, 7Department of

Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

pt

Running title: Prevalence of Dense Breasts in Korean Women

ce

Correspondence: Jae Kwan Jun, MD, PhD

Ac

National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu,

Goyang 10408, Korea

Tel: 82-31-920-2184 Fax: 82-31-920-2929 E-mail: jkjun@ncc.re.kr

This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process which may
lead to differences between this version and the Version of Record. Please cite this article as
an ‘Accepted Article’, doi:10.4143/crt.2018.297

1
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

Abstract

Purpose

Women with dense breast are known to be at high risk for breast cancer, but their prevalence and

number of Korean women are unknown. The current study was to investigate the distribution of

mammographic breast density by age of women undergoing screening mammography, and to

estimate the prevalence of Korean women with dense breasts, quantitatively.

le
Materials and Methods

For obtaining a nationwide representative sample, 6,481 mammograms were collected from 86

ic
screening units participated in the National Cancer Screening Program for breast cancer. Based

t
on the American College of Radiology Breast Imaging Reporting and Data System
Ar
classification, breast density was evaluated by six breast radiologists, qualitatively. We applied

these breast density distributions to age-specific counts of the Korean women population
ed

derived to mid-year 2017 to estimate the number of Korean women with dense breasts.

Results
pt

Overall, 54.4% (95% confidence interval [CI], 52.9% to 55.8%) of women 40 to 69 years of

age had heterogeneously or extremely dense breasts, and this proportion was inversely
ce

associated with age. Based on the age distribution of Korean women, we estimated that

6,083,000 women (95% CI, 5,919,600 to 6,245,600) age 40-69 years in Korean have dense
Ac

breasts. Women aged 40-49 years (n=3,450,000) accounted for 56.7% of this group.

Conclusion

More than half of Korean women aged 40 and over have dense breasts. To prevent breast

cancer effectively and efficiently, it is necessary to develop a new personalized prevention

strategy considering her status of breast density.

Key words Breast density, Prevalence, Mammography, Korea

2
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

Introduction

The mammographic breast density (MBD) is the extent of the radio-opacified

fibroglandular tissue of breast in the mammogram. The MBD, measured qualitatively or

quantitatively, is well-known as a risk factor for breast cancer in Western women [1,2].

Recent studies have reported that it might be a risk factor in Asian women [3,4].

It is used as a surrogate marker of breast cancer prevention [5] and makes a model for

le
predicting a risk of breast cancer in individuals more accurate [6]. Moreover, in women with

ic
dense breast, the MBD makes it difficult to detect breast cancer, which decreases the accuracy

of mammography screening [7,8].

t
Ar
Age is most likely associated with the MBD, which is decreased by age. In addition,

anthropometric, parity, and hormonal factors known as the risk factor of breast cancer are also

associated with the MBD [9]. Although many epidemiological studies including immigration
ed

studies reported that there are ethnic and geographic differences in the MBD [10-14], most of

them have a problem of small sample size and representativeness of populations. In Asian
pt

women, the proportions of women with dense breast may be higher than those of western

women.
ce

Many Korean women are known to have small breast volume and a higher proportion of

dense breasts [15,16]. However, to date, there is no study on the distribution of breast density
Ac

using a large-scale and representative sample of asymptomatic Korean women. The objective

of this study, therefore, is to examine the distribution of MBD by age in women undergoing

screening mammography and estimate the prevalence of Korean women with dense breasts.

Using the recent studies conducted with a representative sample [17,18], we sought to

examine differences between Korean women and other countries.

3
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

Materials and Methods

The Korean Mammographic Density (KoMAD) study was designed to estimate the

prevalence of dense breast representatively and to determine the association between breast

density and breast cancer risk in Korean women. It was conducted from January 2012 to

December 2014. The design and study enrolment have been fully described in detail

previously [4, 19]. Briefly, the eligible population of this study consisted of women aged 40

le
years and over who participated in the National Cancer Screening Program (NCSP) in 2009.

ic
To prevent over-representation of specific regions, the participants were randomly selected

after stratification by 16 administrative districts and the proportion of women aged ≥ 40

t
Ar
years in each region. To ensure accessibility of mammograms, screening units were restricted

to a total amount of mammograms annually. Imaging data were collected from a total of 86

screening units representing their respective district regions. The mammographic images were
ed

obtained from the screening units in the form of original analog film copy or Digital Imaging

and Communication in Medicine (DICOM) file. Among the selected women, 962 women
pt

(12.9%) whose were not stored craniocaudal (CC) and mediolateral oblique (MLO) images of

both breasts, or whose was not re-readable film status, were excluded. Finally, mammograms
ce

for 6,481 women were included in this study.

The MBD was measured qualitatively according to the American College of Radiology
Ac

(ACR) Breast Imaging Reporting and Data System (BI-RADS) classification (4th edition) of

breast density [20]. Six radiologists who are active members of the Korean Society of Breast

Imaging and breast specialists in general hospitals participated in this study. To reduce

variability in evaluating MBD, six breast radiologists were trained in the ACR BI-RADS

classification of breast density. Prior to read mammography images in this study, the inter-

radiologist agreement of ACR BI-RADS classification was evaluated. Based on pilot test,

4
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

radiologists showed substantial agreement for measurement of MBD: the weighted kappa

value for inter-radiologist agreement was 0.83 (95% confidence interval [CI], 0.80 to 0.86)

[21]. They were paired into three groups to read MBD. If two radiologists’ read were not

consistent, they discussed to reach an agreement. Each BI-RADS density grade was classified

as follows [20]: almost entirely fat (0%-25% glandular); scattered fibroglandular densities

(26%-50% glandular); heterogeneously dense (51%-75% glandular); and extremely dense

le
(76%-100% glandular). Density classifications were grouped almost entirely fat and scattered

fibroglandular densities as “fatty breasts” and heterogeneously or extremely dense as “dense

ic
breasts”.

t
We used the distribution of MBD by age groups for estimating prevalence of breast density
Ar
and its 95% CI in Korean women. For estimating counts of women with a dense breast by age

group, we obtained data from the 2017 Korean Census. By multiplying the weighted
ed

frequency by the corresponding mid-year population, we calculated a weighted frequency for

each age group. All other statistical analyses were conducted using SAS Statistical Software,
pt

ver. 9.2 (SAS Institute, Cary, NC).

ce

1. Ethical statement

With permission from the Ministry of Health and Welfare, informed consent for this study
Ac

was not required, which was approved by the Institutional Review Board (IRB) of the

National Cancer Center, IRB number NCC2014-0065.

5
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

Results

Table 1 shows the characteristics of the study participants and their breast densities. About

11.1% of the participants reported having used hormones. This study included 1,212 (18.7%)

women in the ‘almost entirely fat,’ 1,862 (28.7%) women in the ‘scattered fibroglandular

densities,’ 2,212 (34.1%) women in the ‘heterogeneously dense,’ and 1,195 (18.4%) women in

the ‘extremely dense’ groups.

le
Fig. 1 shows the distribution of breast density measured by four BI-RADS categories for

ic
women aged 40 years and older in this study. The highest proportions by each age group were

as follows: extremely dense (44.2%) for aged 40-44 years, heterogeneously dense (43.7%) for

t
Ar
aged 45-54 years, scattered fibroglandular tissue (40.5%) for aged 55-64 years, and almost

entirely fat (53.2%) for aged 65 years and older. The proportions of dense breasts declined

with increasing age. Similar trends were observed when stratified by health insurance status
ed

(S1 Fig.). It sharply decreased in Korean women aged 55-59 years. Women with dense breasts

in their 40s showed more than 70%, but they fell to less than 10% from the age of 65. Overall,
pt

45.6% (95% CI, 44.2% to 47.0%) in the Korean women aged 40 years and older, which was

estimated at 6,420,226 women (95% CI, 6,223,110 to 6,617,340) had heterogeneously or

ce

extremely dense breasts (Table 2). For women aged 40 to 69 years, 54.4% (95% CI, 52.9 to

55.8) and 6,083,000 women (95% CI, 5,919,600 to 6,245,600) were estimated, respectively.
Ac

Our results were compared with prior studies conducted in United States and China is

presented in Fig. 2. Similar to our results, the prevalence of MBD in United States and

Chinese women decreased with increasing age. Until the age of 60, the prevalence of MBD of

Korean women was higher than that of U.S. women. At age 60, U.S. women with dense

breasts began to outstrip Korean women with dense breasts. Within comparable age groups,

the trend in Chinese women was similar to that in Korean women.

6
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

Discussion

We quantitatively estimated Korean women with dense breasts, which might be one of

major risk factors for breast cancer. Among all Korean women aged 40 years and over, who

are the target population of the NCSP for breast cancer, we estimated that the proportion of

women with heterogeneously or extremely dense breasts is approximately 45.6%,

corresponding to approximately 6,420,226 Korean women. Restricted to aged 40-69 years,

le
which most guidelines for breast cancer screening recommend, the proportion was increased

ic
to 54.4% (6,083,000 women).

In comparison to Brian’s study [17], we found differences in the distribution of

t
Ar
mammographic density according age group between women in Korean and United States.

There result of the overall tendency with aging was similar to our results. However, the

proportion of women with dense breasts in Korean was higher than 80% until their late 40s,
ed

and then there was a sharp decrease in the proportion upper 50 years. By comparing the

characteristic change in breast, it is that Korean women in aged between 40 and 54 years were
pt

a much greater proportion of dense breasts than U.S. women, and that the transfer from dense

breasts to fatty breasts tends to change more rapidly than U.S. women. Our results in the
ce

proportion of breast density according age group are similar to prior studies in China and

Japan. The proportion of women with dense breasts in China and Japan was higher in under
Ac

50 years of age, and then breast density tends to decrease with increasing age. But, Setsuko et

al. [22] has limitation in making comparisons with our results because a quoted age standards

are different and absolute density was not evaluation in their study.

Since 2002, the NCSP for breast cancer has been conducted for all Korean women aged 40

years old and over, biennially. To date, the participation rate is about 52% and more than 3.3

million women are receiving screening mammography each year [23]. Higher recall rates of

7
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

NCSP, especially over 20% in aged 40s than those of other screening programs in Western

countries was reported [24]. Women with extremely dense breast were 7 times more likely to

recall than women with almost entirely fatty breast [25]. It might be due to risk of interval

cancer in women with dense breast and concerns about subsequent medical litigation.

An important effect of high breast density is the risk of a false-negative mammography

finding due to the masking effect of dense tissue [7,8]. An interval cancer diagnosed in

le
woman with dense breasts has led to legislation in the United States that mandates disclosure

of breast density information to women undergoing mammography screening. Since breast

ic
density notification law was first enacted in Connecticut in 2009, it has been put into effect in

t
35 states and requires direct screen notification on mammographic results indicating the
Ar
presence of dense breasts [26]. It has been estimated that more than 25 million women with

dense breasts in the United States’ could be affected by the breast density notification laws
ed

[17]. On the other hand, in Korea, the NCSP started to record breast density information in

2009, but it does not notified to participants.

pt

Some limitations of this study regarding interpreting result exist. First, we evaluated MBD

according BI-RADS density classification qualitatively. Although the BI-RADS classification

ce

is widely used, its assessments depend on the ability and experience of radiologists and may

show reader variability. In order to overcome the limitations of qualitative methods,

Ac

quantitative breast density analysis is needed with more objective and higher reproducibility,

but supplying digital radiographic system for mammography is essential. Second, we could

not consider the other factors that can influence breast density in this study, such as the body

mass index, reproductive and hormonal factors, or socioeconomic status. However, our study

minimized the effects of these external factors by applying a representative sampling strategy.

Third, there were discrepancies between the time when the survey was conducted and the

8
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

yearly population data used for estimation of the counts of women with dense breasts.

Although there is no evidence that the prevalence of MBD by age changes with the calendar

year, further studies are required to determine the changes in breast density over time through

repeated measurements.

Despite these limitations, our study is meaningful because this is nationwide survey for

estimating the distribution of MBD among Korean women and counting women with dense

le
breasts quantitatively. It could be utilized as principal evidence for developing the preventing

strategy for breast cancer such as screening.

ic
Our results indicate the underlying prevalence of dense breasts among the Korean women

t
aged 40 years and older. More than half of the Korean women have dense breasts. In spite of
Ar
limited evidences [27], Korean women with dense breasts are recommended supplemental

screening such as breast ultrasonography. More than 19,000 breast cancers are newly
ed

diagnosed each year and it is expected that the number will continue to increase in near future

[28,29]. To prevent breast cancer effectively and efficiently, it is necessary to develop a new
pt

personalized prevention strategy considering her status of breast density.

ce

Conflicts of Interest

Conflict of interest relevant to this article was not reported.

Ac

Acknowledgments

This research was supported by a grant of the Korea Health Technology R&D project

through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of

Health & Welfare, Republic of Korea (grant number: HC15C1257).

9
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

References

1. Boyd NF, Martin LJ, Yaffe MJ, Minkin S. Mammographic density and breast cancer risk:

current understanding and future prospects. Breast Cancer Res. 2011;13:223.

2. Astley SM, Harkness EF, Sergeant JC, Warwick J, Stavrinos P, Warren R et al. A

comparison of five methods of measuring mammographic density: a case-control study.

Breast Cancer Res. 2018;20:10.

le
3. Bae JM, Kim EH. Breast Density and Risk of Breast Cancer in Asian Women: A Meta-

ic
analysis of Observational Studies. J Prev Med Public Health. 2016;49:367-75.

4. Park B, Cho HM, Lee EH, Song S, Suh M, Choi KS, et al. Does breast density measured

t
Ar
through population-based screening independently increase breast cancer risk in Asian

females? Clin Epidemiol. 2017;10:61-70.

5. Nyante SJ, Sherman ME, Pfeiffer RM, Berrington de Gonzalez A, Brinton LA, Aiello
ed

Bowles EJ, et al. Prognostic significance of mammographic density change after initiation

of tamoxifen for ER-positive breast cancer. J Natl Cancer Inst. 2015;107:dju425.

pt

6. Tice JA, Cummings SR, Smith-Bindman R, Ichikawa L, Barlow WE, Kerlikowske K.

Using clinical factors and mammographic breast density to estimate breast cancer risk:
ce

development and validation of a new predictive model. Ann Intern Med. 2008;148:337-47.

7. Trentham-Dietz A, Kerlikowske K, Stout NK, Miglioretti DL, Schechter CB, Ergun MA, et
Ac

al. Tailoring Breast Cancer Screening Intervals by Breast Density and Risk for Women

Aged 50 Years or Older: Collaborative Modeling of Screening Outcomes. Ann Intern Med.

2016;165:700-12.

8. Holm J, Humphreys K, Li J, Ploner A, Cheddad A, Eriksson M, et al. Risk factors and

tumor characteristics of interval cancers by mammographic density. J Clin Oncol.

2015;33:1030-7.

10
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

9. Boyd NF, Rommens JM, Vogt K, Lee V, Hopper JL, Yaffe MJ, et al. Mammographic breast

density as an intermediate phenotype for breast cancer. Lancet Oncol. 2005;6:798-808.

10. Maskarinec G, Nagata C, Shimizu H, Kashiki Y. Comparison of mammographic densities

and their determinants in women from Japan and Hawaii. Int J Cancer. 2002;102:29-33.

11. Maskarinec G, Pagano I, Chen Z, Nagata C, Gram IT. Ethnic and geographic differences

in mammographic density and their association with breast cancer incidence. Breast

le
Cancer Res. 2007;104:47-56.

12. Mariapun S, Li J, Yip CH, Taib NA, Teo SH. Ethnic and geographic differences in

ic
mammographic density and their association with breast cancer incidence. PLoS One.

t
2015;10:e0117568.
Ar
13. McCormack VA, Perry N, Vinnicombe SJ, Silva Idos S. Ethnic variations in

mammographic density: a British multiethnic longitudinal study. Am J Epidemiol.

ed

2008;168:412-21.

14. Habel LA, Capra AM, Oestreicher N, Greendale GA, Cauley JA, Bromberger J, et al.
pt

Mammographic density in a multiethnic cohort. Menopause. 2007;14:891-9.

15. Kim SH, Kim MH, Oh KK. Analysis and comparison of breast density according to age
ce

on mammogram between Korean and western women. J Korean Radiol Soc.

2000;42:1009-14.
Ac

16. Youn I, Choi S, Kook SH, Choi YJ. Mammographic Breast Density Evaluation in Korean

Women Using Fully Automated Volumetric Assessment. J Korean Med Sci.

2016;31:457-62.

17. Sprague BL, Gangnon RE, Burt V, Trentham-Dietz A, Hampton JM, Wellman RD, et al.

Prevalence of mammographically dense breasts in the United States. J Natl Cancer Inst.

2014;106:dju255.

11
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

18. Dai H, Yan Y, Wang P, Liu P, Cao Y, Xiong L, et al. Distribution of mammographic

density and its influential factors among Chinese women. Int J Epidemiol.

2014;43:1240-51.

19. Jun JK, Kim MJ, Choi KS, Suh M, Jung KW. Development of a sampling strategy and

sample size calculation to estimate the distribution of mammographic breast density in

Korean women. Asian Pac J Cancer Prev. 2012;13:4661-4.

le
20. American College of Radiology. Breast Imaging Reporting and Data System, 4th ed.

Reston, VA: American College of Radiology, 2003.

ic
21. Jo HM, Song S, Lee EH, Ko K, Kang BJ, Cha JH, et al. Interpretive volume and inter-

t
radiologist agreement on assessing breast density. J Korean Soc Breast Screening

2018;15:15-22.
Ar
22. Ishihara S, Taira N, Kawasaki K, Ishibe Y, Mizoo T, Nishiyama K, et al. Association
ed

between mammographic breast density and lifestyle in Japanese women. Acta Med

Okayama. 2013;67:145-51.
pt

23. Suh M, Song S, Cho HN, Park B, Jun JK, Choi E, et al. Trends in participation rates for

the National Cancer Screening Program in Korea, 2002-2012. Cancer Res Treat
ce

2017;49:798-806.

24. Lee EH, Kim KW, Kim YJ, Shin DR, Park YM, Lim HS, et al. Performance of screening
Ac

mammography: a report of the Alliance for Breast Cancer Screening in Korea. Korean J

Radiol 2016;17:489-96.

25. Kim YJ, Lee EH, Jun JK, Shin DR, Park YM, Kim HW, et al. Analysis of participant

factors that affect the diagnostic performance of screening mammography: a report of the

Alliance for Breast Cancer Screening in Korea. Korean J Radiol 2017;18:624-31.

26. Are You Dense. Inc. [Internet]. U.S.: Are You Dense Advocary. [cited 2018 Apr 13].

12
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

Available from: http://www.areyoudenseadvocacy.org.

27. Lee EH, Park B, Kim NS, Seo HJ, Ko KL, Min JW, et al. The Korean guideline for breast

cancer screening. J Korean Med Assoc. 2015;58:408-19.

28. Jung KW, Won YJ, Kong HJ, Lee ES; Community of Population-based Regional Cancer

Registries. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in

2015. Cancer Res Treat 2018;50:303-16.

le
29. Jung KW, Won YJ, Kong HJ, Lee ES. Prediction of cancer incidence and mortality in

Korea, 2018. Cancer Res Treat 2018;50:317-23.

t ic
Ar
ed
pt
ce
Ac

13
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

le
t ic
Fig. 1. Distribution of breast density categories of American College of Radiology (ACS)
Ar
Breast Imaging Reporting and Data System (BI-RADS) by age in Korean women.
ed
pt
ce
Ac

14
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

le
ic
Fig. 2. Comparison of prevalences of dense breasts between Korean women, Chinese women

t
[18], and U.S. women [17] by age.
Ar
ed
pt
ce
Ac

15
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

Table 1. General characteristics of the study population

Total (N=6,481)
No. (%)
Age, mean±standard deviation (yr) 55.01±11.0
Age at menarche, years
≤13 546 (8.4)
14-16 3,605 (55.6)
≥17 2,279 (35.2)
Missing 51 (0.8)
No. of live births
0 286 (4.4)

le
1 699 (10.8)
≥2 5,471 (84.4)
Missing 25 (0.4)
Breast feeding (mo)

ic
Never 774 (11.9)
<12 2,128 (32.8)
≥12 3,578 (55.2)

t
Missing 1 (0.0)
Age at menopause (yr)
Premenopausal
<45
Ar 83 (1.3)
259 (4.0)
45-54 3,490 (53.9)
≥55 411 (6.3)
Missing 2,238 (34.5)
ed

Hormone replacement therapy

Never 5,433 (83.8)
Ever 720 (11.1)
Missing 328 (5.1)
pt

Oral contraceptive use (mo)

Never 5,224 (80.6)
<12 622 (9.6)
≥12 320 (4.9)
ce

Missing 315 (4.9)

Past history of benign disease
Yes 528 (8.1)
No 5,459 (84.2)
Ac

I do not know 459 (7.1)

Missing 35 (0.5)
Breast density
Almost entirely fat 1,212 (18.7)
Scattered fibroglandular densities 1,862 (28.7)
Heterogeneously dense 2,212 (34.1)
Extremely dense 1,195 (18.4)

16
Korean Cancer Association
This article is protected by copyright. All rights reserved.
 CANCER RESEARCH AND TREATMENT (CRT)

Table 2. Estimated number of Korean women in each of the ACR BI-RADS breast density categories
Age ACR BI-RADS breast density categorya)

le
group Scattered Dense breastsb)
(yr) Almost entirely fat Heterogeneously dense Extremely dense
fibroglandular densities

ic
40-44 3.09 (1.94 to 4.92) 26.92 (23.16 to 31.17) 82.91 (77.18 to 88.75) 89.36 (83.47 to 95.31) 172.25 (167.82 to 176.21)
45-49 7.57 (5.49 to 10.40) 44.80 (39.62 to 50.47) 102.82 (96.12 to 109.59) 68.91 (62.82 to 75.34) 171.73 (165.79 to 177.24)
50-54 16.83 (14.16 to 19.95) 63.92 (59.18 to 68.84) 83.81 (78.77 to 88.96) 37.20 (33.31 to 41.42) 121.02 (115.87 to 126.04)

t
55-59 41.62 (35.18 to 48.92) 84.54 (76.17 to 93.21) 68.98 (61.01 to 77.48) 16.26 (11.97 to 21.92) 85.26 (76.76 to 94.01)

Ar
60-64 53.35 (47.77 to 59.26) 66.40 (60.46 to 72.51) 36.70 (31.88 to 42.02) 5.02 (3.25 to 7.72) 41.71 (36.62 to 47.25)
65-69 48.66 (42.68 to 54.87) 48.55 (42.60 to 54.72) 19.42 (15.28 to 24.40) 0.85 (0.27 to 2.67) 20.27 (16.05 to 25.32)
70-74 50.40 (45.69 to 55.06) 32.23 (27.95 to 36.82) 12.88 (10.03 to 16.41) 0.69 (0.22 to 2.16) 13.59 (10.64 to 17.17)
75-79 51.22 (46.17 to 56.09) 28.07 (23.63 to 32.93) 8.13 (5.63 to 11.60) 0.88 (0.19 to 3.82) 9.02 (6.31 to 12.72)
≥80 64.13 (54.45 to 73.04) 29.29 (21.67 to 38.37) 11.49 (6.27 to 20.18) N.A. 11.49 (6.27 to 20.18)

ed
40-69c),d) 170.91 (158.76 to 183.82) 335.55 (324.22 to 354.72) 389.95 (397.30 to 405.23) 212.51 (206.38 to 230.84) 608.30 (591.96 to 624.56)

ACR BI-RADS, American College of Radiology Breast Imaging Reporting and Data System; N.A., not available. a)Units: 10,000 women and 95%
confidence intervals, b)Heterogeneously dense or Extremly dense, c)The recommendations by National guidelines for breast cancer screening [ref.
pt
27], d)Estimates may be different from sum of each cells due to rounding, Estimated for data based on 2017 Korean Census counts.
ce
Ac

17
Korean Cancer Association
This article is protected by copyright. All rights reserved.
CANCER RESEARCH AND TREATMENT (CRT)

le
t ic
S1 Fig. Comparision of the prevalences of dense breasts according to the health insurance
Ar
status. NHIS, National Health Insurance Survice; MAP, Medical Aid Program.
ed
pt
ce
Ac

18
Korean Cancer Association
This article is protected by copyright. All rights reserved.